Hemoglobinuria
Myoglobinuria
Finding | Contents | Conditions |
---|---|---|
RBC casts | RBCs | Glomerulonephritis |
WBC casts | WBCs | UTI Glomerulonephritis Acute interstitial nephritis (AIN) |
RTE cell casts | RTE cells | Acute tubular necrosis (ATN) |
Hyaline casts | Mucoprotein | - |
Granular casts | Cellular debris | Acute tubular necrosis (ATN) |
Waxy casts | Cellular debris | Chronic kidney disease (CKD) |
Fatty casts | Lipids | Nephrosis |
Envelope crystals | Calcium oxalate | Ethylene glycol Malabsorption |
Coffin lid crystals | Struvite | Urease-positive pathogens |
Rhomboid crystals | Uric acid | Hyperuricemia |
Hexagonal crystals | Cystine | Cystinuria |
Mechanism | Mnemonic | Medication | Location | K | H | Ca |
---|---|---|---|---|---|---|
Carbonic anhydrase inhibitors | Abnormal | Acetazolamide | Proximal convoluted tubule (PCT) | ↓ | ↑ | - |
Na-K-2Cl sympoter blockers | Loss | Loop diuretics: Furosemide Bumetanide Torsemide | Ascending loop of Henle | ↓ | ↓ | ↓ |
Na-Cl sympoter blockers | Through | Thiazides: Hydrochlorothiazide Chlorthalidone | Distal convoluted tubule (DCT) | ↓ | ↓ | ↑ |
Na channel blockers | Kidney | K-sparing diuretics: Amiloride Triamterene | Collecting tubule (CT) | ↑ | ↑ | - |
Mineralocorticoid receptor antagonists (MRA) | Kidney | K-sparing diuretics: Spironolactone Eplerenone | Collecting tubule (CT) | ↑ | ↑ | - |
Mechanism | Dialysis | Ultrafiltration |
---|---|---|
Transport | Diffusion | Convection |
Drive | Concentration gradient | Pressure gradient |
Removal | Small molecules | All molecules & Water |
Fluids | Dialysate | Replacement fluid |
Variable | Prerenal | Renal | Postrenal |
---|---|---|---|
Urine osmolality | > 500 | < 350 | - |
Urine Na | < 20 | > 40 | - |
FENa | < 1% | > 2% | - |
Serum BUN/Cr | > 20 | < 15 | - |
Stage | Cr | GFR | Urine |
---|---|---|---|
Risk | 1.5x ~ 2x | 50 ~ 75% | < 0.5 mL/kg/h for 6 ~ 12 hours |
Injury | 2x ~ 3x | 25 ~ 50% | < 0.5 mL/kg/h for 12 ~ 24 hours |
Failure | > 3x ↑ > 0.5 mg/dL to > 4.0 mg/dL | < 25% | < 0.3 mL/kg/h for > 24 hours 0 mL/kg/h for > 12 hours |
Loss | Failure > 4 weeks | ||
ESRD | Failure > 3 months |
Stage | Cr | Urine |
---|---|---|
1 | 1.5x ~ 2x ↑ > 0.3 mg/dL | < 0.5 mL/kg/h for 6 ~ 12 hours |
2 | 2x ~ 3x | < 0.5 mL/kg/h for 12 ~ 24 hours |
3 | > 3x ↑ > 0.5 mg/dL to > 4.0 mg/dL | < 0.3 mL/kg/h for > 24 hours 0 mL/kg/h for > 12 hours |
Stage | GFR |
---|---|
1 | > 90 |
2 | 60 ~ 90 |
3a | 45 ~ 60 |
3b | 30 ~ 45 |
4 | 15 ~ 30 |
5 | < 15 |
Glomerulopathy | Nephritis | Nephrosis | LM/IF/EM | IC Shape | IC Location | C3 | Associations |
---|---|---|---|---|---|---|---|
IgA nephropathy [Berger disease] | + | - | Mesangial proliferation | Mesangial | Mesangial | - | HSP |
Alport syndrome | + | - | GBM thinning GBM splitting Basket-weave appearance | - | - | - | - |
Anti-GBM disease [Goodpasture syndrome] | + | - | Crescent shape | Linear | GBM | - | - |
ANCA-associated vasculitis (AAV) | + | - | Crescent shape | - | - | - | - |
Rapidly progressive glomerulonephritis (RPGN) | + | - | Crescent shape | - | - | - | Anti-GBM ANCA |
Acute proliferative glomerulonephritis (APGN) | + | - | Lumpy-bumpy appearance Starry sky appearance | Granular | Subepithelial | ↓ | GAS |
Membranoproliferative glomerulonephritis (MPGN) | + | + | Mesangial proliferation GBM thickening GBM splitting Tram-track appearance | Granular | Subendothelial | ↓ | SLE HBV HCV |
Diffuse proliferative glomerulonephritis (DPGN) | + | + | Wire looping appearance | Granular | Subendothelial | ↓ | SLE |
Membranous nephropathy | - | + | GBM thickening Spike-and-dome appearance | Granular | Subepithelial | - | Anti-PLA2R SLE HBV HCV |
Minimal change disease (MCD) | - | + | Podocyte effacement | - | - | - | - |
Focal segmental glomerulosclerosis (FSGS) | - | + | Segmental sclerosis Hyalinosis Podocyte effacement | - | - | - | HIV SCD |
Diabetic nephropathy | - | + | Nodular sclerosis GBM thickening | - | - | - | - |
Amyloid nephropathy | - | + | Nodular sclerosis | - | - | - | - |
Type | Synonym | Defect | Serum K | Serum H |
---|---|---|---|---|
1 | Distal | H secretion | ↓ | ↑ |
2 | Proximal | HCO3 reabsorption | ↓ | ↑ |
3 | Mixed | - | ↓ | ↑ |
4 | Hyperkalemic | Aldosterone | ↑ | ↑ |
Type | Urgency | Nocturia | Residual volume | Etiology |
---|---|---|---|---|
Stress | - | - | - | Pelvic relaxation |
Urge | + | + | ↓ | Overactive bladder (OAB) |
Overflow | - | + | ↑ | Underactive bladder (UAB) |
Grade | Description |
---|---|
1 | Reflux to the ureter |
2 | Reflux to the pelvis |
3 | Dilatation of the ureter & pelvis & calyx |
4 | Blunting of the fornix |
5 | Loss of papillary impressions |
Patient | Antibiotics |
---|---|
Outpatient | Nitrofurantoin TMP-SMX Fosfomycin Amoxicillin & Clavulanate 1° Cephalosporins |
Outpatient & Complicated | 3° Cephalosporins Fluoroquinolones |
Inpatient | 3° Cephalosporins Fluoroquinolones |
Inpatient & Complicated | Vancomycin & Carbapenems |
Timing | Volume (mL) | Managment |
---|---|---|
PVR | < 200 | - |
PVR | 200 ~ 400 | Intermittent catheterization |
PVR | > 400 | Indwelling urinary catheter |
Random | < 400 | Bladder scan Q2H |
Random | > 400 | Indwelling urinary catheter |